基于IMRT的Ⅱ期鼻咽癌同期放化疗与单纯放疗远期疗效比较

doi:10.3760/cma.j.issn.1004-4221.2017.04.002

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (780 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的评价以IMRT为基础的不同治疗模式对Ⅱ期鼻咽癌患者预后的影响。方法回顾分析123例Ⅱ期鼻咽癌患者的临床资料,其中单纯放疗81例,同期放化疗42例。Kaplan-Meier计算生存率并Logrank检验。结果全组5年OS、LRFS、DMFS、PFS分别为96.7%、94.7%、93.1%、87.8%。单纯放疗组与同期放化疗组相比,5年OS (98.7%:92.9%,P=0.569)、LRFS (94.8%:94.5%,P=0.770)、DMFS (94.5%:90.2%,P=0.408)、PFS (90.6%:82.2%,P=0.340)均无明显差异。T₂N₁期患者两组5年各项生存率仍无明显差异(P=0.929、0.967、0.917、0.492)。急性不良反应方面同期放化疗组中性粒细胞减少、白细胞减少、血红蛋白减少和放射性黏膜反应发生率明显升高(P=0.000、0.000、0.012、0.010),而两组晚期不良反应发生率相近(P=0.823、0.622、0.113)。结论对Ⅱ期患者同期化疗的加入并未改善患者预后,但急性不良反应明显增加。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	孙学明
	陈春燕
	韩非
	卢泰祥

关键词 ：鼻咽肿瘤/放化疗法, 放化疗法,同期, 放射疗法,调强, 预后

Abstract：

Objective To compare the long-term efficacy between intensity-modulated radiotherapy (IMRT) alone and concurrent chemoradiotherapy (CCRT) in the treatment of stage Ⅱ nasopharyngeal carcinoma (NPC) patients. Methods The clinical data of 123 patients with stage Ⅱ NPC were retrospectively analyzed. Eighty-one patients received IMRT alone,and 42 patients received CCRT.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used to compare the survival rates. Results The 5-year overall survival (OS),local recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),and progression-free survival (PFS) rates in all patients were 96.7%,94.7%,93.1%,and 87.8%,respectively. There were no significant differences between the patients receiving IMRT alone and CCRT in 5-year OS (98.7% vs.92.9%,P=0.569),LRFS (94.8% vs. 94.5%,P=0.770),DMFS (94.5% vs. 90.2%,P=0.408),and PFS (90.6% vs. 82.2%,P=0.340).For patients with stage T₂N₁ NPC,the 5-year OS,LRFS,DMFS,and PFS also showed no significant differences between those receiving IMRT alone and CCRT (P=0.929,0.967,0.917,0.492).The incidence rates of neutropenia,leukopenia,and mucositis were significantly higher in patients receiving CCRT than in those receiving IMRT alone (P=0.000,0.000,0.012,0.010),while the incidence of late toxicities was similar between the two groups of patients (P=0.823,0.622,0.113). Conclusions For stage Ⅱ NPC patients treated with IMRT,the addition of concurrent chemotherapy fails to improve the prognosis,and increases the incidence of acute toxicities.

Key words： Nasopharygeal neoplasms/chemoradiotherapy Chemoradiotherapy,concurrent Radiotherapy,intensity-modulated Prognosis

收稿日期: 2016-03-14

通讯作者: 卢泰祥,Email:lutx@mail.sysu.edu.cn

引用本文:

孙学明,陈春燕,韩非等. 基于IMRT的Ⅱ期鼻咽癌同期放化疗与单纯放疗远期疗效比较[J]. 中华放射肿瘤学杂志, 2017, 26(4): 376-379.

Sun Xueming,Chen Chunyan,Han Fei et al. Comparison of long-term efficacy between concurrent chemoradiotherapy and intensity-modulated radiotherapy alone for stage Ⅱ nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(4): 376-379.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.04.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I4/376

[1] Xiao WW,Han F,Lu TX,et al. Treatment outcomes after radiotherapy alone for patients with early-stage nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2009,74(4):1070-1076.DOI:10.1016/j.ijrobp.2008.09.008
[2] Chua DT,Sham JS,Kwong DL,et al. Treatment outcome after radiotherapy alone for patients with Stage Ⅰ-Ⅱ nasopharyngeal carcinoma[J].Cancer,2003,98(1):74-80
[3] 宗井凤,马骏,唐玲珑,等.鼻咽癌综合治疗策略研究——749例疗效分析[J].中国肿瘤,2005,14(8):538-542.
Zong JF,Ma J,Tang LL,et al. Comprehensive treatment strategy of nasopharyngeal carcinoma:analysis of 749 cases[J].Chin Cancer,2005,14(8):538-542
[4] Chen QY,Wen YF,Guo L,et al. Concurrent chemoradiotherapy vs. radiotherapy alone in stage Ⅱ nasopharyngeal carcinoma:phase Ⅲ randomized trial[J].J Natl Cancer Inst,2011,103(23):1761-1770.DOI:10.1093/jnci/djr432
[5] 苏胜发,赵充,韩非,等.早期鼻咽癌单纯调强放疗的远期疗效评价[J].中华放射肿瘤学杂志,2011,20(1):1-4.DOI:10.3760/cma.j.issn.1004-4221.2011.01.001.
Su SF,Zhao C,Han F,et al. Long term efficacy of intensity-modulated radiotherapy for early nasopharyngeal carcinoma[J].Chin J Radit Oncol,2011,20(1):1-4.DOI:10.3760/ cma.j.issn.1004-4221.2011.01.001
[6] Xu T,Hu C,Wang X,Shen C.Role of chemoradiotherapy in intermediate prognosis nasopharyngeal carcinoma[J].Oral Oncol,2011,47(5):408-413.DOI:10.1016/j.oraloncology.2011.03.008
[7] 赵充,卢泰祥,韩非,等.139例鼻咽癌调强放疗的临床研究[J].中华放射肿瘤学杂志,2006,15(1):l-6.
Zhao C,Lu TX,Han F,et al. Clinical study of intensity modulated radiotherapy for nasopharyngeal carcinoma:a report of 139 cases[J].Chin J Radit Oncol,2006,15(1):l-6
[8] Butler EB,The BS,Grant WH,et al. Smart (simultaneous modulated accelerated radiation therapy) boost:a new accelerated fraetionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy[J].Int J Radiat Oncol Biol Phys,1999,45(1):21-32
[9] Wong FC,Ng AW,kP VH,et alWhole field simultaneous integrated—boost intensity.modulated radiotherapy for patients with nasopharyngeal carcinoma[J].Int J Radiat Oncol Bid Phys,2010,76(1):138-145.DOI:10.1016/j.ijrobp.2009.01.084.
[10] Tham IW,Lin S,Pan J,et al. Intensity-modulated radiation therapy without concurrent chemotherapy for stage Ⅱ_b nasopharyngeal cancer[J].Am J Clin Oncol,2010,33(3):294-299.DOI:10.1097/COC.0b013e3181 d2edab.
[11] 江少娜,李飞,谢丽,等.T_1-2N₁M₀期鼻咽癌IMRT同期化疗疗效分析[J].中华放射肿瘤学杂志,2015,24(5):529-532.DOI:10.3760/cma.j.issn.1004-4221.2015.05.013.
Jiang SN,Li F,Xie L,et al. Efficacy analysis of IMRT concurrent chemotherapy for stage T_1-2N₁M₀ nasopharyngeal carcinoma[J].Chin J Radit Oncol,2015,24(5):529-532.DOI:10.3760/cma.j.issn.1004-4221.2015.05.013.
[12] Chua DT,Sham JS,Au GK,et al. Concomitant chemoirradiation for stage Ⅲ-IV nasopharyngeal carcinoma in Chinese patients:results of a matched cohort analysis[J].Int J Radiat Oncol Biol Phys,2002,53(2):334-343.
[13] Chau RM,Teo PM,Kam MK,et al. Dosimetric comparison between 2-dimensional radiation therapy and intensity modulated radiation therapy in treatment of advanced T-stage nasopharyngeal carcinoma:to treat less or more in the planning organ-at-risk volume of the brainstem and spinal cord[J].Med Dosim,2007,32(4):263-270.
[14] Kam MK,Chau RM,Suen J,et al. Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional plans and feasibility of dose escalation[J].Int J Radiat Oncol Biol Phys,2003,56(1):145-157.
[15] Lee AW,Sze WM,Au JS,et alTreatment results for nasopharyngeal carcinoma in the modem era:the Hong Kong experience[J].Int J Radiat Oncol Biol Phys,2005,61(4):1107-1116.